Emory University

Children’s Clinical and Translational Discovery Core

1760 Haygood Dr. E-264 Atlanta, GA 30322

Use Proposal Form

Please submit this form to to indicate your interest in discussing and entering into a research agreement with the Emory University Children’s Clinical and Translational Discover Core (CCTDC) for use of human biospecimens and/or associated data.

The CCTDCScientific Review Committee will use the information you provide in this form to ensure that your request is properly reviewed for scientific merit and clinical relevance,assess and advise on any potential regulatory and ethical issues, and begin to identify candidate samples.

On initial submission, please provide as much information as possible. After collaboration with the CCTDCScientific Review Committee, the form will be submitted for committee review.

Please Include:

  1. Date Submitted:
  1. Project/Study Title:
  1. Investigator(s)
  2. Name:
  3. Institution:
  4. Address:
  5. Phone Number:
  6. Email Address:
  1. Specific Aims/Study Objectives - Briefly indicate the scientific questions to be answered by analysis of the study samples and data.
  1. Brief Justification:
  2. Background/Scientific Rationale - Should be sufficient to clarify the rationale for the study.
  3. Preliminary Data/Relevant Bibliography
  1. Study Design/Methods (as it relates to the use of biospecimens)
  2. The problem to be studied
  3. The exact nature/number of specimens that will be required - All proposals are required to provide justification for the number of specimens requested. If a large number of samples are being requested, a power analysis may be required as part of the justification of the sample size.
  4. Proposed procedures/testing -If the laboratory analysis methods you will use are well-recognized and thoroughly described in the medical literature, cite references. Otherwise, please describe these in detail.
  1. Additional Specimen Information Required - Please detail any other information needed and explain.
  1. Funding Information - Requests for samples may be prioritized. If so, specimens will be provided to investigators on a rotating basis in the following priority order: peer reviewed funded investigators, new investigators and academic investigators developing new research projects, and other investigators.
  1. Supply a copy of each of the following:
  2. Biographical Sketch
  3. Signed Agreement for the use of Biological Specimens Form (attached)
  4. Institutional Review Board approval must be obtained and a letter from the chairperson of your IRB must accompany this application (samples will not be distributed unless a current Human Subjects approval letter is in our files). This can be an exemption letter from your IRB if the IRB deems appropriate.

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